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Dtsch Med Wochenschr 2013; 138(04): 145-151
DOI: 10.1055/s-0032-1327401
Übersicht | Review article
Immunologie
© Georg Thieme Verlag KG Stuttgart · New York

Impfen bei Immundefekten oder medikamentöser Immunsuppression

Vaccinations in patients with immunodeficiency or immunosuppressive therapy
D. Boršo
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
,
M. Löbermann
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
,
C. Fritzsche
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
,
C. Hemmer
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
,
A. Führer
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
,
U. Zettl
2   Klinik für Neurologie, Universitätsmedizin Rostock
,
E. C. Reisinger
1   Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
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Further Information

Publication History

25 February 2012

08 November 2012

Publication Date:
15 January 2013 (online)

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Zusammenfassung

Aufgrund des erhöhten Infektionsrisikos bei immundefizienten und immunsupprimierten Patienten sollten Impfungen konsequent zur Vermeidung von Infektionskrankheiten eingesetzt werden. Je nach Ausprägung der Immundefizienz oder Immunsuppression ändern sich die Indikationen und Kontraindikationen zu Impfungen. Gemäß den aktuellen Empfehlungen der Ständigen Impfkommission am Robert-Koch-Institut (STIKO) besteht für diese Patienten keine Kontraindikation für Totimpfstoffe. Je nach Ausprägung der Immundefizienz kann die Impfantwort jedoch reduziert sein oder ganz ausbleiben, daher ist eine Kontrolle des Impftiters zu empfehlen. Lebendimpfungen galten bei immungeschwächten Patienten wegen lebensbedrohlicher Komplikationen lange als absolut kontraindiziert. Heute kann im Einzelfall eine Indikation für bestimmte Lebendimpfungen gestellt werden.

Abstract

Patients with immunodeficiency and patients under immunosuppressive therapy have an increased risk of infectious diseases. Vaccination strategies are needed to protect them from preventable diseases. The underlying disease and severity of the immune impairment may have influence on indications and contra-indications of vaccines. Inactivated vaccines can be administered safely according to the current recommendations of the Permanent Commission on Vaccinations of the Robert-Koch-Institut in Berlin, Germany (STIKO). Depending on the severity of the immune dysfunction, antibody response to vaccinations varies. Where possible, the antibody response following vaccinations should be tested. Previously, attenuated live vaccines were considered to be strictly contra-indicated in immunocompromised patients. Today, the administration of attenuated live vaccines is thought to be possible, depending on the degree and type of immunodeficiency or immunosuppression of the individual.

Schlüsselwörter

Impfen - Totimpfstoff - Lebendimpfstoff - Immundefekt - Immunsuppression - Sicherheit - Wirksamkeit

Keywords

Immunization - inactivated vaccine - attenuated live vaccine - immunodeficiency - immunosuppression - safety - efficacy
 

  • Literatur

  • 1 Anonymous. Measles immunization in HIV-infected children. American Academy of Pediatrics. Committee on Infectious Diseases and Committee on Pediatric AIDS. Pediatrics 1999; 103: 1057-1060
    CrossrefPubMedSearch in Google Scholar
  • 2 Anonymous. Passive Immunization. In: Pickering LK, Baker CJ, Long SS, McMillan JA, Hrsg. Red Book: 2006 Report of the Committee on Infectious Diseases. 27. Aufl. Illinois: American Academy of Pediatrics; 2006: 71-72
    Search in Google Scholar
  • 3 Anonymous. General recommendations on immunization – recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60: 1-64
    PubMedSearch in Google Scholar
  • 4 Beam Jr TR, Crigler ED, Goldman JK et al. Antibody response to polyvalent pneumococcal polysaccharide vaccine in diabetics. JAMA 1980; 244: 2621-2624
    CrossrefPubMedSearch in Google Scholar
  • 5 Bekker V, Westerlaken GH, Scherpbier H et al. Varicella vaccination in HIV-1-infected children after immune reconstitution. Aids 2006; 20: 2321-2329
    CrossrefPubMedSearch in Google Scholar
  • 6 Bilukha OO, Rosenstein N. Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005; 54: 1-21
    PubMedSearch in Google Scholar
  • 7 Borleffs JC, Schneider MM. Routine vaccination in HIV-infected patients: a review. Neth J Med 1994; 45: 244-249
    PubMedSearch in Google Scholar
  • 8 Brigden ML. Detection, education and management of the asplenic or hyposplenic patient. Am Fam Physician 2001; 63: 499-506, 508
    PubMedSearch in Google Scholar
  • 9 Castro P, Plana M, Gonzalez R et al. Influence of a vaccination schedule on viral load rebound and immune responses in successfully treated HIV-infected patients. AIDS Res Hum Retroviruses 2009; 25: 1249-1259
    CrossrefPubMedSearch in Google Scholar
  • 10 CDC. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins for persons with altered immunocompetence. MMWR Recomm Rep 1993; 42: 1-18
    PubMedSearch in Google Scholar
  • 11 CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46: 1-24
    PubMedSearch in Google Scholar
  • 12 CDC. Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease. . http://www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guide-508.pdf verändert: 20.09.2010
    PubMed
  • 13 CDC. Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. MMWR Morb Mortal Wkly Rep 2009; 58: 1042-1043
    PubMedSearch in Google Scholar
  • 14 CDC. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR Recomm Rep 2001; 49: 1-128
    PubMedSearch in Google Scholar
  • 15 Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol 2010; 125: 195-203
    CrossrefPubMedSearch in Google Scholar
  • 16 Colquhoun AJ, Nicholson KG, Botha JL et al. Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes. Epidemiol Infect 1997; 119: 335-341
    CrossrefPubMedSearch in Google Scholar
  • 17 Cornejo-Juarez P, Volkow-Fernandez P, Escobedo-Lopez K et al. Randomized controlled trial of Hepatitis B virus vaccine in HIV-1-infected patients comparing two different doses. AIDS Res Ther 2006; 3: 9
    CrossrefPubMedSearch in Google Scholar
  • 18 Debat Zoguereh D, Ruiz JM. [Immunosuppression and vaccinations]. Sante 2000; 10: 211-219
    PubMedSearch in Google Scholar
  • 19 Duchini A, Goss JA, Karpen S et al. Vaccinations for adult solid-organ transplant recipients: current recommendations and protocols. Clin Microbiol Rev 2003; 16: 357-364
    CrossrefPubMedSearch in Google Scholar
  • 20 Feuerhake A, Muller R, Lauchart W et al. HBV-vaccination in recipients of kidney allografts. Vaccine 1984; 2: 255-256
    CrossrefPubMedSearch in Google Scholar
  • 21 Fonseca MO, Pang LW, de Paula Cavalheiro N et al. Randomized trial of recombinant hepatitis B vaccine in HIV-infected adult patients comparing a standard dose to a double dose. Vaccine 2005; 23: 2902-2908
    CrossrefPubMedSearch in Google Scholar
  • 22 Geretti AM, Brook G, Cameron C et al. British HIV Association guidelines for immunization of HIV-infected adults 2008. HIV Med 2008; 9: 795-848
    CrossrefPubMedSearch in Google Scholar
  • 23 Gluck T, Muller-Ladner U. Vaccination in patients with chronic rheumatic or autoimmune diseases. Clin Infect Dis 2008; 46: 1459-1465
    CrossrefPubMedSearch in Google Scholar
  • 24 Hilgendorf I, Freund M, Jilg W et al. Vaccination of allogeneic haematopoietic stem cell transplant recipients: Report from the International Consensus Conference on Clinical Practice in chronic GVHD. Vaccine 2011; 29: 2825-2833
    CrossrefPubMedSearch in Google Scholar
  • 25 Hoffmann C, Rockstroh JK. HIV 2010. Hamburg: Medizin Fokus Verlag; 2010
    Search in Google Scholar
  • 26 Kapetanovic MC, Saxne T, Nilsson JA et al. Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients. Rheumatology (Oxford) 2007; 46: 608-611
    CrossrefPubMedSearch in Google Scholar
  • 27 Kroger AT, Atkinson WL, Marcuse EK et al. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006; 55: 1-48
    PubMedSearch in Google Scholar
  • 28 Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis 2009; 9: 493-504
    CrossrefPubMedSearch in Google Scholar
  • 29 Lederman MM, Schiffman G, Rodman HM. Pneumococcal immunization in adult diabetics. Diabetes 1981; 30: 119-121
    CrossrefPubMedSearch in Google Scholar
  • 30 Lobermann M, Borso D, Hilgendorf I et al. Immunization in the adult immunocompromised host. Autoimmun Rev 2012; 11: 212-218
    CrossrefPubMedSearch in Google Scholar
  • 31 Loebermann M, Winkelmann A, Reisinger EC et al. [Vaccination and multiple sclerosis]. Nervenarzt 2010; 81: 181-193
    CrossrefPubMedSearch in Google Scholar
  • 32 Looijmans-Van den Akker I, Verheij TJ, Buskens E et al. Clinical effectiveness of first and repeat influenza vaccination in adult and elderly diabetic patients. Diabetes Care 2006; 29: 1771-1776
    CrossrefPubMedSearch in Google Scholar
  • 33 Machado CM. Reimmunization after bone marrow transplantation – current recommendations and perspectives. Braz J Med Biol Res 2004; 37: 151-158
    CrossrefPubMedSearch in Google Scholar
  • 34 McFarland E. Immunizations for the immunocompromised child. Pediatr Ann 1999; 28: 487-496
    PubMedSearch in Google Scholar
  • 35 Melmed GY, Agarwal N, Frenck RW et al. Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. Am J Gastroenterol 2010; 105: 148-154
    CrossrefPubMedSearch in Google Scholar
  • 36 Morath C, Arns W, Schwenger V et al. Sirolimus in renal transplantation. Nephrol Dial Transplant 2007; 22 (Suppl. 08) viii61-viii65
    CrossrefPubMedSearch in Google Scholar
  • 37 Patel SR, Ortin M, Cohen BJ et al. Revaccination of children after completion of standard chemotherapy for acute leukemia. Clin Infect Dis 2007; 44: 635-642
    CrossrefPubMedSearch in Google Scholar
  • 38 Pozzilli P, Gale EA, Visalli N et al. The immune response to influenza vaccination in diabetic patients. Diabetologia 1986; 29: 850-854
    CrossrefPubMedSearch in Google Scholar
  • 39 Rahier JF, Moutschen M, Van Gompel A et al. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology (Oxford) 2010; 49: 1815-1827
    CrossrefPubMedSearch in Google Scholar
  • 40 Rentenaar RJ, van Diepen FN, Meijer RT et al. Immune responsiveness in renal transplant recipients: mycophenolic acid severely depresses humoral immunity in vivo. Kidney Int 2002; 62: 319-328
    CrossrefPubMedSearch in Google Scholar
  • 41 Riley 3rd TR, Bhatti AM. Preventive strategies in chronic liver disease: part II. Cirrhosis. Am Fam Physician 2001; 64: 1735-1740
    PubMedSearch in Google Scholar
  • 42 Rousseau MC, Moreau J, Delmont J. Vaccination and HIV: a review of the literature. Vaccine 1999; 18: 825-831
    CrossrefPubMedSearch in Google Scholar
  • 43 Smith KG, Isbel NM, Catton MG et al. Suppression of the humoral immune response by mycophenolate mofetil. Nephrol Dial Transplant 1998; 13: 160-164
    CrossrefPubMedSearch in Google Scholar
  • 44 STIKO. Hinweise zu Impfungen für Patienten mit Immundefizienz. Epidemiol Bull 2005; 39/2005: 353-364
    PubMedSearch in Google Scholar
  • 45 STIKO. Stellungnahme zur Impfung Erwachsener gegen Pneumokokken. Epidemiol Bull 2012; 7/2012: 55-56
    PubMedSearch in Google Scholar
  • 46 STIKO. Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2012. Epidemiol Bull 2012; 30/2012: 283-310
    PubMedSearch in Google Scholar
  • 47 Sung L, Heurter H, Zokvic KM et al. Practical vaccination guidelines for children with cancer. Paediatr Child Health 2001; 6: 379-383
    PubMedSearch in Google Scholar
  • 48 Suttorp M. Impfungen bei Kindern mit fehlender oder geschwächter Immunabwehr. Immunologie und Impfen 1999; 2: 70-76
    CrossrefPubMedSearch in Google Scholar
  • 49 Tomblyn M, Chiller T, Einsele H et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15: 1143-1238
    CrossrefPubMedSearch in Google Scholar
  • 50 Urschel S, Cremer S, Birnbaum J et al. Lack of serologic immunity against vaccine-preventable diseases in children after thoracic transplantation. Transpl Int 2009; 23: 619-627
    CrossrefPubMedSearch in Google Scholar
  • 51 van Assen S, Holvast A, Benne CA et al. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum 2010; 62: 75-81
    CrossrefPubMedSearch in Google Scholar
  • 52 van den Berg R, van Hoogstraten I, van Agtmael M. Non-responsiveness to hepatitis B vaccination in HIV seropositive patients; possible causes and solutions. AIDS Rev 2009; 11: 157-164
    PubMedSearch in Google Scholar
  • 53 WHO. Priority interventions: HIV/AIDS prevention, treatment and care in the health sector – 2010. Geneva: WHO Press; 2010
    Search in Google Scholar